School of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany.
Department of Psychology, University of Kassel, Kassel, Germany.
Clin Psychol Psychother. 2024 Jul-Aug;31(4):e3036. doi: 10.1002/cpp.3036.
Increased attention has recently been paid to the well-being and flourishing of patients in psychotherapy. This study investigated the occurrence of positive affect (PA) and strength-based behaviours within psychotherapy sessions contrasting positive versus neutral imagery instructions.
This is a secondary analysis of a randomized controlled trial. Seventy-eight sessions of cognitive behavioural therapy involving 26 patients (69.23% female; M = 40.31) treated by 13 therapists were selected. PA and strength-based behaviours of patients and therapists were coded on a minute-by-minute basis with the Resource-Oriented Microprocess Analysis. Each session started with a brief mental imagery instruction. Data were analysed using multilevel modelling.
Mild levels of PA were very common, whereas stronger expressions were occasional, especially at the beginning and end of sessions. Strength-based behaviours were employed in one-fifth of the videos analysed. Therapists in the positive imagery instruction showed more strength-based behaviours in the beginning phase of sessions, p < 0.05. The two imagery instructions significantly differed in the session trajectories of PA, p < 0.05. A quadratic trend with higher initial values and a sharper decline in PA were found in the positive instruction, whereas the neutral instruction showed a flatter trend.
Patients and therapists experience PA and discuss strengths in psychotherapy sessions despite patients' distress. The positive imagery instructions potentially induced a positive focus at baseline for therapists but had a negligible effect on the subsequent session progression.
ClinicalTrials.gov identifier: NCT03767101 (registered December 6, 2018).
最近人们越来越关注心理治疗中患者的幸福感和繁荣。本研究通过对比积极意象指导和中性意象指导，调查了积极情绪（PA）和基于优势的行为在心理治疗过程中的发生情况。
这是一项随机对照试验的二次分析。从 26 名患者（69.23%为女性；M=40.31）的 78 次认知行为治疗中选取了 13 名治疗师的治疗过程，这些患者的治疗过程均包含简短的心理意象指导。患者和治疗师的积极情绪和基于优势的行为是使用资源导向的微观分析方法，按照每分钟进行编码的。每个疗程都从一个简短的心理意象指导开始。数据采用多层建模进行分析。
轻度积极情绪非常常见，而更强的情绪表达则较为偶然，尤其是在疗程的开始和结束时。在分析的视频中，有五分之一采用了基于优势的行为。在疗程的开始阶段，积极意象指导下的治疗师表现出更多的基于优势的行为，p<0.05。两种意象指导在 PA 的疗程轨迹上有显著差异，p<0.05。在积极指令中，发现了一个初始值较高且 PA 下降较陡的二次趋势，而中性指令则显示出较为平坦的趋势。
尽管患者感到痛苦，但患者和治疗师在心理治疗过程中确实会体验到积极情绪，并讨论自身的优势。积极意象指导有可能在治疗师的基线时产生积极的焦点，但对随后的疗程进展几乎没有影响。
ClinicalTrials.gov 标识符：NCT03767101（2018 年 12 月 6 日注册）。
